Organization
CENTER FOR SPINE & SPORTS REHABILITATION PC
Active
Organization
CENTER FOR SPINE & SPORTS REHABILITATION PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THELMA LYNETTE GREEN-MACK MD (PRESIDENT)
(317) 920-3220
Entity
Organization
Contact information
Practice address
3850 SHORE DR STE 305, INDIANAPOLIS, IN 46254-4693
(317) 920-3220
(317) 920-3222
Mailing address
3850 SHORE DR STE 305, INDIANAPOLIS, IN 46254-4693
(317) 920-3220
(317) 920-3221
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
01037601B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000092241
ANTHEM BCBS
IN
01
—
10815817
CAQH - COUNCIL FOR AFFORDABLE QUALITY HEALTHCARE
IN
01
—
1346439239
NPI NATIONAL PROVIDER IDENTIFER GROUP
IN
01
—
1841358017
NPI NATIONAL PROVIDER IDENTIFER INDIVIDUAL
IN
01
—
250010985
RAILROAD MEDICARE
IN
Enumeration date
10/17/2007
Last updated
02/22/2023
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